The new year, 2019, brought a continued rapid pace to Matt’s rehabilitation. The intensity of the earlier months had been immense, yet showed no sign of slacking off. Key to Matt’s future success was building foundational abilities, fostering new levels of independence, and reintegration into a widening circle of daily life. This period, leading up to the one-year anniversary of his accident in April, saw his therapeutic journey evolve, with each discipline playing a vital, ongoing role.

In occupational therapy, the emphasis was on keeping things fresh, offering variety to pique Matt’s interest. They worked on doing two-handed tasks, such as juggling, pretending to carry a box of laundry, or pulling wet clothes out of the washing machine. Instead of a children’s bouncy ball, they bounced and caught a tennis ball together.

It was fascinating to watch their sessions of mirror therapy. Matt’s right hand was hidden behind a mirror, with his left hand in front. Jacqui instructed Matt to move both hands, whether to wave, wiggle fingers, or turn the palm up and down. He could see the reflection of his left hand moving, which gave the appearance he was doing likewise with his right hand, and equally as well. Creating this visual feedback can "trick" the brain, and potentially improve movement in the affected limb.

As great as Matt’s health insurance was, his annual combined allotment for occupational and speech therapy visits wouldn't last the year. We opted to stop OT and, when necessary, reduce speech therapy sessions to once a week and pay out of pocket, at the discounted rate offered by the hospital's financial assistance program. Mike and I felt competent to carry the baton and advance his skills at home to an adequate level of engagement, much like occupational therapy. This included applying Matt’s skills to daily living tasks, such as cooking, cleaning, and self-care; fine motor activities, including typing and writing; cognitive work through games and academics; and physical exercises utilizing a homemade pegboard and mirror therapy setup to replicate Jacqui’s treatment. Thankfully, she would still be available to answer questions and offer advice. To compensate for fewer speech visits, we'd increase the frequency of weekly sessions using the Constant Therapy App at home, from two or three sessions to daily. Fortunately, at least physical therapy had unlimited coverage as long as Matt continued to make steady progress.

holding a conversation. He also had Matt scan left for five steps, then straight ahead for five steps, and finally five steps looking right, repeating this pattern while maintaining a straight path along the length of the clinic and back. Stair work remained a favorite, as they honed maneuvers like stepping and pausing mid-stride, stepping sideways up and down, taking two steps at a time, or carrying a medicine ball or a full glass of water.

Five months in a wheelchair had left Matt stiff and with a hunched posture. A physical therapist from a nearby RTC clinic specialized in Therapeutic Yoga and highlighted its potential to improve his body awareness, core stability, and posture. The focus was on releasing tight chest muscles, the pelvic region, shoulders, and hips to help relax and open his posture. Sessions evolved to include Restorative Yoga, shifting from passive release to active movement and functional integration. Matt attended five to six sessions before I was adequately trained to perform these strategies at home. The various yoga poses, release techniques, and fluid motions seemed to have the desired effect, increasing hip and shoulder flexibility and improving head and chest positioning.

Beyond the physical, vision therapy continued to play a critical role in Matt's cognitive and perceptual recovery. I enjoyed watching Vision Therapy sessions and learning the reasons behind the different interventions. Matt batted a ball suspended on a string in patterns other than straight ahead, such 

Late in January, Matt's vision was re-evaluated. Compared to September, his ability to converge his eyes was assessed at 95%, and his visual pursuit and eye teaming were considered "dramatically better." Unfortunately, his right peripheral vision remained quite impaired, but the "piece of the pie" that was missing had shrunk—we’ll take this win. Our plan was to continue his home exercises and return for a recheck and new program in three months.

Jessica, the speech pathologist, would become an essential part of our team. Our professional relationship was relatively new prior to Matt's accident. In my role as a department coordinator, our initial opportunities to develop a firm foundation were inconsistent due to her split schedule not always coinciding with mine. Yet, we still connected on business development and collaborative discussions about procedures in both inpatient and outpatient services. While we didn't always see eye-to-eye, Jessica once shared that, “I deeply valued the professionalism with which we could agree to disagree and maintain a fulfilling professional relationship. As a fellow working mother of three, I appreciate her anecdotes and advice. It was through these conversations that I knew of Matt long before he became my patient.”

Beyond our work, Jessica recalls that while I was dealing with my crisis, she was facing one of her own. She was touched that I supported her, having "sent handwritten notes of encouragement to her home and regularly made sure to ask how she and her family were doing.” Little did Jessica know, she was the one person I mustered enough willpower and reserved energy to truly hear and retain, much but not all, of the details she shared. My head and attention were so laser-focused on everything Matt, it took everything I had to keep my act together enough to show up at work and concentrate on the immediate needs. For everyone else, their chatter went in one ear and out the other, never finding a perch. Unable to fully attend to and reciprocate the generous support and encouragement everyone gave me, I chose to impact just one person who was also facing an unfavorable situation. She was "struck by my deeply personal and compassionate interaction with all staff." I'm glad I was successful in that small effort.

“Sarah's success in work and as a mother is undoubtedly due to a tenacity rarely seen in others—a tenacity clearly shared by Matt," Jessica recalled. She noted my steadfastness in overseeing massive projects from inception to completion, creating many departmental processes that are still adhered to today. These very qualities, Jessica realized, fueled my primary mission of rehabilitating Matt. During his speech sessions, I'd intently listen, ask questions, take notes, and later research the things she'd mentioned, or meticulously record them in journals for follow-up.

I regularly asked questions and shared details about Matt's speech and social interactions at home. Jessica used this feedback to build targeted therapy sessions. For instance, if I mentioned he began helping in the kitchen again, she would plan a multi-targeted activity to build on his functional efforts. This might involve listing ingredients, problem-solving how to replace missing items, reasoning through grocery acquisition without transportation, and recalling the sequence of steps after reviewing them earlier in the appointment.

In those sessions, Jessica gained a deeper understanding of Matt's apraxia of speech—his brain's struggle to properly sequence and program the movements of his mouth and tongue to produce sounds. They performed repetitive drills of phonemes (distinct sounds) and simple, single-syllable words, gradually progressing to more challenging, longer words as he improved.

Meanwhile, their language work focused on naming tasks to address Matt's anomia—the inability to recall the names of everyday objects. They started with nouns, then moved to verbs and adjectives, simultaneously assessing his comprehension through follow-up one-step commands. After that, they worked on constructing grammatically correct, simple sentences for function and conversation (e.g., "How are you today, Matt?" Matt: "I am good"). They also tackled advanced comprehension tasks, such as following two- or three-step commands or answering simple questions after hearing a sentence (e.g., "Jane went downstairs to answer the phone. Did Jane go downstairs? Did she answer the front door?").

As the anniversary of his accident approaches, it'll mark a shift from acute recovery to the long-haul work of rebuilding. Each session, whether in the clinic or at home, was a testament to Matt's resilience and the unwavering commitment to his progress. While the challenges remained significant, the consistent efforts across all disciplines, fueled by collaboration and personal dedication, ensured that the journey forward continued, step by painstaking step, towards an ever-brighter horizon.

© 2025, Sarah Watkins